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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLE WWW.bold.pro/my/Candidate's Name
PROFESSIONAL SUMMARYMedical Administrative Professional organized and dependable candidate who successfully managed multiple priorities with a positive attitude. Works productively with facilities, provider groups, and individual professionals. Knowledgeable and adaptable with a willingness to learn new things.WILLINGNESS TO TAKE ON ADDED RESPONSIBILITIES TO MEET TEAM GOALSEDUCATIONKeiser University, Fort Lauderdale, FL2019Associate of Science, Medical AdministrativePROFESSIONAL EXPERIENCECapital Staffing Solutions INC, Fully Remote05/23 presentProvider Credentialing & Data ManagementResolves escalated provider issues and serves as a senior resource to the department and other internal customersConducted primary source verifications such as background checks, and board certifications, Obtained NPI numbers for providers and facilities and updated existing profiles.Capital Staffing Solutions INC, Fully Remote10/22 04/23Risk Adjustment & STARS Medical Records Review SpecialistPerform QA Reviews on all medical records to ensure CMS and HHS documentation requirements and retrieve medical records that meet specific NCQA/ STARS requirements. Handles telephone, email, and fax communication with provider offices and vendors to retrieve medical records and set up onsite medical records visitsCollaborate with other business areas in problem-solving, solution development strategic planning, and decision-making while following all laws and regulations associated with CMS STAR Program, HEDIS quality metrics, and AHRQ. Perform multiple projects in a matrix organization while proving success in managing projects.Maximus Federal, Fully Remote09/21 09/22Quality Control AnalystReviewed Medical Disability Examination (MDE) reports & Disability Benefits Questionnaires (DBQs) for accuracy and consistency with the DBQ as well as ease follow-up to obtain any missing information to ensure reports are by Department of Veterans Affairs (the VA) guidelines.Served as a liaison between the various internal departments, practitioners, and veterans professionally and courteously while keeping privacy and confidentiality.Emory Healthcare Network, Decatur, GA06/08 08/21Quality Improvement & Reporting SpecialistDeveloped Standards of Operations and departmental workflow to promote continuous quality improvement within the department while showing areas of improvement to increase workflow efficiency and standardization.Collaborated with insurance payers to find high-risk populations in efforts to reduce healthcare costs, promote health education, and maximize gap closure and members of an interdisciplinary care team to develop strategic plans to address gap coverage.SKILLSActive Listening *MS Word* Excel *PowerPoint *Provider enrollment *Provider Relations *Accreditation information management *Written and verbal communication *Records management *Records review *Utilization review *Process updates |
